Breast Cancer: Reducing your lifetime risk – the evidence

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As awareness of breast cancer increases, interest is growing around ways to prevent it. Breast cancer survivors are especially likely to make risk reduction a priority. Yet there is so much misunderstanding about “risk” which in public health is not merely an emotive word, but a statistical concept with a precise meaning. Some known risks cannot easily be controlled – such as your genes, the age at which you begin menstrual cycles, and the age at which you reach menopause. It is believed that inherited risk accounts for around 10% of all breast cancers. Other known risk factors such as the timing of pregnancy, birth and breastfeeding, often involve choice but – realistically – are not likely to shift in respect of what amounts to a relatively small improvement in lifetime breast cancer risk. On the other hand, information claiming to be authoritative about cancer prevention is often promoted to the public, despite offering little solid scientific support for interventions that may not only be inconvenient but also – often – quite costly. There is a clear need for researchers to sort through the facts, the myths and the concerns, for everyone’s sake. Research of this nature is difficult and expensive; large samples of women must be followed for long periods of time, after giving accurate, detailed accounts of health behaviours or environmental exposures. Nonetheless, the research is being done and the results are being made available. In 2011, the Institute of Medicine in the USA reviewed the evidence base for environmental risk factors associated with breast cancer. The entire report can be downloaded here. Six risk factors The following six risk factors emerged with strong research support from this review. 1. Ionising radiation. This radiation is involved in X-rays and CT scans. Ionising radiation separates electrons from their atoms, creating an intra-cellular electrical charge which is capable of breaking DNA, the machinery of cellular reproduction. Cells damaged in this way will mostly die or be repaired by the body’s own defence mechanisms, but some may continue to reproduce forming a cancer growth. Until recently, it was assumed that normal X-rays were not a significant source of radiation exposure, but researchers have found that the “dose effect” is to some extent cumulative. So a few X-rays done when really necessary are not of concern, but repeated X-ray imaging should be avoided. CT scans (Computerised Tomography) which build up a picture using multiple X-rays involve large doses of ionising radiation and are definitely cause for concern, especially in children – though despite the increased cancer risk the use of a CT scan may still be safer than alternatives such as exploratory surgery. The US Food and Drug Administration provides detailed...

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Arm activity post surgery

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Physiotherapist guidance for arm activity following breast surgery Check with your doctor about relative restrictions on exercises following surgery, although most exercises can start on the day after surgery.  Your surgeon may request a physiotherapist to help you with some of the exercises initially.  It may take two to three months for you to recover full use of your arm.  If you are having specific problems with moving your shoulder, ask your doctor regarding a referral to a physiotherapist. Shoulders are made to have full movement and your arm will feel best when this is achieved.  You are encouraged to use your elbow and hand as much as possible, within the limits of your pain, from as soon as you can after surgery. For the first few days following surgery, deep breathing exercises are advised.  Lie on your back and breathe in until your lower chest expands, then exhale and relax.  Repeat three or four times to help you relax and also gently expand your chest on the operated side. “Normal” shoulder movement implies that you have the ability to reach across the top of your head to touch the opposite ear without a stretchy feeling in you armpit (axilla).  Use this as a guide to measure your progress.  Shoulders are made to have full range of movement, and you will probably only feel comfortable once you have reached your normal. Generally, it is okay to stretch your shoulder until you feel a mild pull, but no pain. Stretches should always be done slowly and smoothly.  You can stretch up to three times a day.  Consult your doctor or physiotherapist if you are unsure. The stiffness and tightness in your chest after surgery and radiation therapy will come and go for a while.   Start with activities that will assist your normal day-to-day activities: reach into cupboards, wash and dry your hair, fasten your bra. After the stitches have been removed and the wound has healed fully, you may start massaging the scar for approximately 10 minutes after a warm bath or shower.  Use circular movements to cover the scar and surrounding areas, to ensure optimal flexibility of the scar tissue. If swelling persists after surgery, elevate the arm at a 45º angle on pillows.   Apply heat packs (warm, not hot) to the limb, and do pumping exercises with the...

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Physiotherapist services for breast cancer surgery patients

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The majority of women diagnosed with breast cancer will require surgery and for those who need a mastectomy, many choose to go on to have breast reconstruction.  Physiotherapy plays an important role in recovery after breast cancer surgery. Physiotherapy treatment is aimed at restoring and maintaining normal, pain-free movement.  Some women will also require radiotherapy after surgery and physiotherapy can help women regain the movement in the arm needed to be comfortable in the position this treatment is given in.   Physiotherapy services for breast cancer treatment patients pre-operative and post-operative assessment (to attain baseline information on the shoulder and arm, and provide the patient with education regarding exercise and lymphoedema) education on the physical effects of breast cancer treatment and how to minimize post-treatment complications customized post-surgical rehabilitation programmes, based on the phase of breast cancer treatment, to restore range of motion, strength, aerobic capacity and function creation of individual home exercise programmes, with regular reassessment of progress and modification of the programme as needed instruction in scar mobilization techniques simple self-massage technique home care and education Who would benefit? Patients who have received medical treatment for breast cancer including: surgery (mastectomy, lumpectomy, axillary dissection, reconstruction) radiation chemotherapy hormonal therapy Possible physical side effects of breast cancer treatment pain decreased shoulder range of motion decreased upper extremity muscle strength decreased cardiopulmonary function soft tissue fibrosis fatigue axillary web syndrome / lymphatic cording syndrome, which is inflammation of the lymph vessels sensory loss neuropraxia lymphoedema (see later) backache, poor posture and reduced function psychosocial impacts: anxiety, depression, fears, concerns, changes in life patterns, adjusted activity These possible side effects may be reduced with education and a customized, safe exercise programme designed by a knowledgeable physiotherapist. Physiotherapists are experts in addressing these issues and can provide advice and treatment to ensure optimal recovery and promote return to normal function.     Positive effects of exercise after breast cancer surgery improved quality of life improved cardiopulmonary function improved upper extremity range of motion improved upper extremity strength decreased fatigue improved venous and lymphatic flow improved functional abilities lower risk of death from breast cancer Research studies have identified a strong association between lower levels of physical activity and higher cancer mortality. Physical activity, such as walking or cycling an average of 30 minutes / day, can improve cancer survival by 33%....

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